STGIL 9 1861. SANITARY STATISTICS AND PROCEEDINGS IN ST. GILES'S DISTRICT. Being a Report on the Sanitary Condition of the District in 1861; and on the Means that have been taken for its Improvement during the Year ending March 25th, 1862; ADDRESSED TO THE LOCAL BOARD OF WORKS. BY GEORGE BUCHANAN, M.D., Lond., Member of the Royal College of Physicians ; Physician to the London Fever Hospital, and Assistant-Physician to the Hospital for Sick Children, &c., &c. Medical Officer of health. London T. PENNY, PRINTER, 121, LEMAN STREET, WHITECHAPEL. 1862. 1861. ANNUAL REPORT OF THE Medical Officer of health. SECTION L—On the Mortality of the Metropolis in 1861. London, with a population of 2,803,939 at the census, lost 68,001 of its inhabitants by death in the year 1861. The death-rate 23.18 per thousand is somewhat higher than the average of the few past years. It is higher than that of 1860 or 1859, lower than in 1858. No one class of disease was specially remarkable for its fatality in London. Zymotic diseases were below the average, though not nearly to the same extent as in 1860. Small-pox, after the epidemic of 1859-60, showed a striking decrease in deaths. Measles, scarlatina, and whooping-cough were less fatal in 1861 than in the years immediately preceding. However, before the end of the year, scarlatina resumed a distinctly epidemic character. Diarrhoea, which had been surprisingly absent in the previous year, doubled the number of its deaths in 1861, but still remained less fatal than in 1859. Fever had, during several former years, shown a very gratifying decrease, but in the latter half of 1861, it was unusually fatal and has since grown into a serious epidemic of typhus, which, at the date of this Report, (June, 1862), is still hanging over the metropolis. Of Consumptive disorders and Diseases of the Lungs, the other causes of death that most vary from year to year, it will be enough to say that their mortality has been high, but not to an extraordinary degree. The same is true for the other two large classes of Brain and Heart disease. Of the five groups of districts into which London is divided by the Registrar-General, the northern and central groups experienced, in 1861, almost the whole of the rise in mortality. In the northern group of districts the death-rate rose from 21.74 and 21.24 in the thousand, at which it had stood in 1859 and 1860, to 22.30 per thousand in 1861. And in the central group of districts, which comprehends St. Giles's, the death-rate of 25.04 per thousand in 1861, was higher than it has been in any of the five preceding years, even higher than in the very unhealthy year 1858. (Appendix I ) The progress of fatal disease in London through the four quarters of the year has been of course unequal, some diseases being more fatal in the cold than in the warm months and the reverse. But besides the variations directly dependent on season, the year 1861 has shown some other fluctuations in its quarterly mortality, especially in the decline of measles and whooping-cough, and the rise of scarlatina, typhus and other forms of continued fever. (Appendix IV.) SECTION II.—On the aggregate mortality of St. Giles's in 1861. Comparison with neighbouring districts. Fourteen hundred and sixty-one persons belonging to St. Giles's district died in 18G1. Of these deaths, 1,385 were returned by the local registrars, aud 76 occurred in the hospitals of adjacent districts. (Appendix II.) Of the 1,461 deaths, 755 were of males, 706 of females. Of the 76 deaths in hospitals, 52 were of males. 6 Six hundred and thirty-five, or 43.5 per cent. of the deaths were of children under five years of age. Four hundred and fifty-eight or 31.4 per cent. of the total deaths were of children who had not reached two years of age. This enormous infantile mortality is unfortunately only what is customary in our district. A hundred and forty persons only, or less than one in ten reached the natural term of three score years and ten. The average age at death was just 28 years. (Appendix III ) The mortality was thus distributed through the four quarters of the year:—The first quarter was as usual in large excess, having 445 deaths; the second quarter gave 337, and the third 288 deaths; and in the fourth quarter there was again a rise to 391. (Appendix IV.) The deaths from all causes in St. Giles's, in 1861, represent a deathrate of 27.03 per thousand; this is a rise of 0.8 in the thousand above the death-rate of 1860, but it is still 1.0 per thousand below the death-rate that prevailed at and before 1857. The rise in the St. Giles's death-rate in 1861, above that of previous years, is almost identical in amount with the rise that was observed in London as a whole. The rise was not so great as was witnessed either in the northern or the central divisions of the town. The mortality of St. Giles's is still, therefore, far above that of the average metropolis, viz., by nearly four in the thousand, Comparing St. Giles's with the districts immediately adjacent to it, we find that it had, in 1861, (the first time that this has been observed) a rival in its eminently high death-rate. (See Table on following page.) Holborn district gave 27 04 deaths per thousand of its inhabitants. At some distance Mary lebone stood next in its mortality, with 24.25 deaths per thousand. The Strand and. Saint Martin's districts were close upon the average of the town giving each 23 37 deaths per thousand. And St. Pancias was below the average of London, having a death-rate of 22.83 only. In every one of these districts there has been some rise above the mortality of 18()0, the rise being less than that of St. Giles's in the Strand and St. Martin's, greater than that of St. Giles's in St. Pancras, Marylebone, and especially in Holborn. In making each of these comparisons, correction has been duly made for deaths in hospitals and in outlying workhouses. (See next page and Appendix II.) The death-rate of 1861 is compared in greater detail with that of former years in the subjoined scheme, where London at large, St. Giles's, and the districts which lie around St. Giles's, have their death-rate (per ten thousand for creater nicety) examined for the past five years. Death-rate per 10,000* in St. Giles's and neighbouring Districts. Districts. 1857 1858 J 859 1860 1861 St. Pancras 197.0 224.9 221.4 208.7 2283 St. Marylebone 217.3 224.0 225.0 227.7 242.5 Metropolis 221.0 234.4 227.0 224.1 231.8 Holborn 236.3 247.7 248.6 238.7 270.4 Strand 239.4 226.6 262.9 231.5 233.7 St. Martin 243.0 218.5 246.7 228.6 233.7 St. Giles's 280.0 258.2 260.1 262.4 270.3 * Correction is here made for the longer duration of the registration year 1857. Also for all deaths in hospitals and outlying workhouses. MORTALITY IN 1861. Districts. Population, 1861 Census. REGISTERED MORTALITY. Column A. Column B. (see Note.) Total Mortality in 1861, corrected for Cols. A. & B. Districts. 1st Quarter, 13 Weeks. 2nd Quarter, 13 Weeks. 3rd Quarter, 13 Weeks. 4th Quarter. 13 Weeks. Whole Year, 52 Weeks. Actual number. per 10,000. Actual number. per 10,000 Actual number. per 10,000. Actual number. per 10,000 Actual number. per 10,000 (add) (subtract.) Actual number per 10,000 St. Pancras 198,882 1490 749 1105 55.6 1034 520 1069 53.7 4698 235.2 86 Hospitals 125 Work. Strand 119 244 4540 228.3 St. Pancras. St. Marylebone 161,609 1268 785 945 58.5 884 54.7 889 55.0 3986 246.7 91 Hospital, 158 3919 242-5 St. Maryle- bone. Metropolis 2,803,939 18965 67.6 15238 54.3 14932 53.2 15866 56.6 65001 231.8 — — 65001 231.8 Metropolis. Holborn 44,861 385 85.8 309 689 234 52.2 301 67.1 1229 274.0 73 Hospital, 89 1213 270.4 Holborn. Strand 42,956 237 668 232 54.0 218 50.8 233 54.2 970 225.8 Work. 119 Hosps. 36 155 Hospital, 121 1004 233.7 Strand. St. Martin's 22,636 162 71.5 160 70.7 124 54.8 123 54.4 569 251.4 11 Hospital, 51 529 233.7 St. Martin's. St. Giles's 54,049 426 78.8 318 58.9 273 50.5 373 69.0 1390 257.2 76 Subtract 5 ( errors.) 1461 270.3 St. Giles's. * Col. A, gives the number of the Inhabitants of each District who expired in 1860, in the Public Institutions of other Districts: these figures must be added to the Registered Mortality. Col. B. gives the number of Inhabitants of other Localities, who died in the same year in the Public Institutions of the Districts named; these figures have to be subtracted from the Registered Mortality. (See Appendix Table II.) 8 SECTION III.—On the Causes of Death, in St. Giles's District. In table III of the Appendix will be found in detail the causes of the 1,461 deaths that occurred in the past year among persons belonging to St. Giles's district. Here, too, the ages at death are shown. The diseases prevailing in each quarter of the year are given in Appendix IV. Referring, therefore to these tables for minuter information and for actual numbers, the enquiry may proceed at once to the relative fatality of various diseases in St. Giles's as compared with the other districts. Failing more particular data, London as a whole furnishes a valuable standard of comparison. St. Giles's contains l÷51-88th part of the population of London. That share of the mortality of London may be called the quota of deaths for the residents of St. Giles's, and this quota has been taken in the opposite table for each class and order of disease. Thus estimated, some causes of death are found to be particularly rife in St. Giles's, others to be less frequent than its population would lead us to expect. In the table, the quota stands side by side with the actual mortality from each class of causes ; some of the more interesting facts may be extracted for comment. (See Table.) Zymotic Diseases numbered 307 or 28 above their quota. In 1860, their number was much lower, (264) and in 1859 it was much higher (3/4) than in the year just past; herein following to an exaggerated degree* the variation that these diseases have exhibited in London as a whole. The members of this class that were in 1861 especially fatal in St. Giles's were measles which prevailed most in the first quarter of the year; scarlatina, whose excessive mortality occurred in the last quarter; to a small degree continued fever including typhus, in the latter half of the year ; and croup which all the year through was unduly fatal.† Some other diseases of the zymotic class have been less fatal in St. Giles's than their calculated amount. Small-pox did not produce a single death in the year, the one that is placed to the account of this disease having been a case where chicken-pox contributed to the fatal result. Whooping cough was slightly below its estimated quota, and (which is an unusual circumstance) diarrhoea was less fatal in St. Giles's than in the average of the town. Diseases of the Constitutional class include the important group of consumptive disorders, and from these in 1861, as in former years, St. Giles's experienced an excessive mortality. There were 281 deaths instead of the calculated 209 from consumptive diseases. Diseases of the various parts and organs of the body—Local diseases— were also in excess in St. Giles's. This excess obtained in all the important sub-divisions of the class. Diseases of the Brain, of the Heart, of the Lungs, of the Kidneys, were all fatal in this district beyond the average of London. Intemperance, overwork, poverty, and exposure, are conditions which lead to these diseases, and all these causes are active among the St. Giles's population. * The law has been before insisted on in these reports,—that the exceptional character of a season in respect of any disease is most marked in districts where that disease is habitually prevalent, and this equally whether the exceptional character be on the side of excess or subsidence. In districts where the disease in question is habitually infrequent below the average, the exceptional character of a season in respect of that disease is but little marked. † It is not improbable that some deaths preceded by laryngismus stridulus (false croup or crowing respiration) are registered as occurring from croup. This false croup is found almost solely in children who have rickcts, a disease very prevalent in St. Giles's and having nothing to do with the zymotic class. Comparison of Mortality from various causes in London *and in Saint Giles. Whole Year, 1881, Classes. Classes and Orders of Disease. London. Sr. Giles', Population, 54049. Population, 2,803 939 Estimated Quota.* Actua1 Registered Mortality. Corrected for Deaths in Hosptls. A11 Causes 65001 1252.9 1385 1461 Specified Causes 64288 1239.1 1368 1440 Classes. I Zymotic Diseases 15710 302.8 328 339 11 Constitutional „ 13002 252.1 299 315 III Local „ 25569 492.9 598 635 IV Developmental „ 7680 148.0 120 120 V Violent Deaths 2247 43.3 23 31 I Orders. 1 Miasmatic Diseases 14459 278.7 297 307 2 Enthetic „ 390 75 17 17 3 Dietic 720 13.9 12 13 4 Parasitic „ 141 2.7 2 2 II 1 Diathetic Diseases 2258 43.5 32 34 2 Tubercular „ 10821 208.7 267 281 III 1 Diseases of Nervous System 6736 129.8 162 166 2 „ Organs of Circulation 2850 54.9 71 79 3 „ Respiratory Organs 11735 226.2 292 303 4 „ Digestive Organs 2735 52.7 49 53 5 „ Urinary Organs 899 17.3 17 24 6 „ Organs of Generation 206 4.0 3 3 7 „ Organs of Locomotion 174 3.4 2 4 8 „ Integumentary Organs.. 234 4.5 2 3 IV 1 Dev: Dis. of Children 2037 39.3 35 35 2 „ „ Adults 250 4.8 4 4 3 „ „ Old People 2516 48.5 54 54 4 Diseases of Nutrition 2877 55.4 27 27 V 1 Accident or Negligence 1870 36.0 14 21 2 Suicide 261 5.1 5 5 All other Violent Deaths 116 2.2 4 5 Sudden Deaths 164 3.2 1 1 Cases unspecified 549 10.6 16 20 Certain Special Diseases of Zymotic Class and Miasmatic Order - 1.1. Small Pox 215 4.1 1 1 Measles 1070 21.6 32 32 Scarlatina 2358 45.4 67 68 Diphtheritis 697 13.4 12 14 Group 855 16.5 42 43 Whooping Cough 3497 67.4 54 54 Diarrhoea 2625 51.8 32 33 Typhus & other Fevers, continued and remittent 1852 35.7 43 44 * 1÷ 51.88 part of the entire mortality of the Town. The Registered Mortality has been subjected to a small reduction for errors. 10 Deaths from the two remaining classes of causes, Developmental diseases and Violence, were less numerous in St. Giles's than would be estimated from their fatality in London. They were also fewer in actual number in 1861 than in former years. "Disease unspecified." lastly, was materially more often returned as a cause of death in St Giles's than elsewhere. The deplorable facility with which a certificate for burial can be obtained under the existing registration laws has been before noticed in these reports. Special comment is made on the subject in § VI of the present. SECTION IV.—On the Localization of Disease and Death in St. Giles's in 1861. A. In Sub-districts. The deaths registered in the several sub-districts do not accurately express the real mortality of each. Persons from each sub-district die in distant hospitals, and persons previously resident in North St. Giles's or in Bloomsbury are returned by the Registrar of St. Giles's South if they are taken to the Workhouse before their death. Making the necessary corrections from an examination of the books of the workhouse and of the various hospitals, the 14C1 deaths of St. of the various hospitals, the 1461 deaths of St. Giles's were distributed in the three sub-districts in the following way:— Deaths of residents in sub-district of Dyirrg at own Homes. Dying in Hospitals. Dying in Workhouse. Total. Bloomsbury 332 13 11 356 St. Giles's South 429 44 73" 546 (Workhouse Inmates) — — 79 79 St. Giles's North 410 19 51 480 Whole District 1171 76 214 1461 Three hundred and fifty six deaths in Bloomsbury represent a deatlh rate of its parisioners of 20.5 per thousand. The residents of St. Giles's South (excluding the workhouse inmates) died at the rate of 29.1 per thousand, while those of St. Giles's North died at the rate of 27.9 per thousand. Comparing these figures with the results of former years (and taking the rate tier ten thausand to avoid fractions) we have the following:—. Death-rate per 10,000* in sub-districts. DISTRICTS. 1857. 1858. 1859. 1860. 1861. St. George, Bloombury 180 198 184 185 205 St. Giles's South 357 292 349 346 291 St. Giles's North 283 277 240 247 279 Whole District 280 253 260 262 270 • Correction has been made for the extra length of the registration year 1857. Bloomsbury and St. Giles's North, then, had an unusually high mortality ; St. Giles's North as high as in 1857-8, and higher than in 1859-60; Bloomsbury considerably higher than in any of the four preceding years. St. Giles's South, on the other hand experienced a diminished mortality, for 11 here it was as low as in the healthiest of the four previous years. It must be observed however that in 1859.60, there had been a very high death-rate in this last sub-district, so that, apart from sanitary improvement, a year of low mortality would be likely to follow. Here as a set-off to the deaths may be found a space to note the births in the three sub-districts, in so far as they were registered. Registered Births in Sub-districts. sob-districts. 1857. 1858. 1859. 1860. 1861. St. George, Bloomsbury 398 403 411 430 416 St. Giles's South 860 717 780 786 808 St. Giles's North 592 557 538 562 532 Whole District 1850 1677 1729 1778 1756 Here it may be noticed that the sub-district where the deaths were few had an unusual number of births, while in the two sub-districts where the mortality was higher than in 1860, the births of 1861 fell below their numbers in that year. B. Considering, for the rest the ten smaller localities into which it has customary in these reports to divide the district of St. Giles, we shall get a more accurate account of the distribution of mortality and shall be enabled with more advantage to consider the causes of death specially prevalent in each neighbourhood. The boundaries of the ten localities may now be assumed to be known. Ten Sub-Divisions of St. Giles's; their order of Mortality from all causes, 1861- Order of Sequence, 1861. Locality of Actual number of Deaths in 1861. Total Mortality per 10,000. Iu Houses. In Workh In Hosptls Total. Best 1st. A. Bedford-square 50 0 1 51 129 2nd. B. Russell-s quare 71 2 6 79 142 3rd. L. Lincoln's Inn-fields 35 1 4 40 177 4th. D, Bloomsburv-square 109 3 3 115 219 5th, (X Coram-street 142 6 6 154 252 6th H. Nothern Drury-lane 100 26 13 139 270 7th. K. Southern Drury-lane. 119 16 14 149 295 8th. E. Church-lane 118 19 6 143 306 9th. F. Dudlev-street 248 33 12 293 324 Worst... 10 th G. Short's Gardens 179 29 11 219 347 Workhouse Inmates, &c. — 79 — 79 — Whole District 1171 214 76 1161 270 The highest mortality from all causes prevailed in the neighbourhood of Short's Gardens, around (but not including) the workhouse. Here the deathrate was 34.7 per thousand, being nearly three times the mortality of the most healthy district around Bedford Square. The locality of Dudley Street was the next worst in the number of its deaths, giving 32.4 per 1000. Highest and best op the list stood as usual the neighbourhoods of Bedford Square, 12 Russell Square and Lincoln's Inn Fields. The localities which in 1861 held an unusual position in respect of their aggregate mortality, were chiefly two: (a) that of Coram Street, which gave in this year a quarter more deaths than than usual, and (b) the parts to the north-east of Drury Lane where there has ordinarily been a very high death-rate, but which had in 1861 only the average mortality of St. Giles's as a whole. Knowing that children under five years of age contribute so largely to the whole mortality, we are prepared to expect, what appears on the following table, that the localization of Infantile deaths is almost identical with that of the deaths at all ages. Here for the first time are separated deaths among iufants under three months of age. The Ten Sub-Divisions—their Order of Infantile Mortality in 1861. Order of Sequence, 1861. Locality of Deaths among Children in 1861. Infantile mortality per 1(1,001) residents. Under 3 months. 3 months to 2 years. 2 years to 5 years. Total under 5 years. Best 1st. A. Bedford-square 7 5 1 13 33 2nd. B. Russell-square 6 10 6 22 39 3rd. L. Lincoln's Inn-fields 5 7 5 17 75 4th D. Bloomsbury-square . 9 28 14 51 97 5th. C. Coram-street 8 38 22 68 111 6th. H. Northern Drury-lane 17 24 18 59 114 7th. K. Southern Drury-lane 11 39 18 68 134 8th. F. Dudley-street 33 66 47 146 162 9th. E. Church-lane 8 52 17 77 165 Worst 10th. G. Short's-gardens 25 51 29 105 166 Workhouse Inmates 5 3 — 8 - Whole District 134 323 177 634 117 Here is to be remarked the astonishing fact that five young children die in the poorer districts of St. Giles's to every one that dies in the better localities of Bedford and Russell Squares. It is not too strong to say that three at least out of every five of these deaths might be and ought to be prevented. Yet this waste of infantile life is not exceptional in St. Giles's. Every year has witnessed the same thing to about the same degree. Discrepancy between the various districts is even more strongly marked in the Zymotic diseases that have infested them. While Bedford Square locality lost only one in a thousand of its residents from complaints of this kind, three of the ten localities lost seven, and one of them, Church Lane, lost approximately nine persons in the thousand from the same class of diseases. Compared with the experience of former years, there is some peculiarity in the distribution of this class of diseases in 1861. They were less fatal than usual in the two sub-districts of St. Giles's parish which lie to the east of Drury Lane. They were more fatal than usual in the Bloomsbury Square and Church Lane localities, but especially in the neighbourhood of Coram Street. In this last district a serious epidemic of scarlatina prevailed in 1861. In the culs de sac leading off Little Coram Street, on the Foundling Estate, this disease was three times more fatal than in the worst parts of St. Giles's. Measles was most prevalent in Church Lane and its neighbourhood; whooping cough in the Dudley Street locality. The epidemic of typhus fever found its head-quarters about Short's Gardens and gave several fatal cases in all the other localities, those in the north of Great Russell Street being less affected The Ten Localities—their Order of Mortality from Zymotic Diseases, (Miasmatic Order) 1861. Order of Sequence, 1861. Locality of Deaths from Miasmatic Diseases in 1861. Zymotic mortality per 10,000. All miasmatic Diseases. Small Pox. Measles. Scarlet Fever. Dipbtheritis. Whooping Cough. Typhus, & c., Fever. Diarrhoea. Other miasme. Diseases. Best 1st. A. Bedford-ssquare 4 — — — 1 1 — 9 — 10 2nd B. Russel-square 15 — — 5 2 2 2 2 9 27 35 3rd. L. Lincoln's Inn-field 8 2 2 — — 1 2 1 4th-6th H. Northern Drury-lane. 28 — — 5 1 2 5 4 11 54 D. Bloomsbury-square. 29 — — 9 — 7 6 2 5 55 K. Southern Drury-lane. 29 — 2 4 1 2 7 6 7 57 7th-9tb. C.Coram-stree 43 1 3 2 3 9 7 3 9 9 70 G. Short's-gardens 44 — 6 8 1 6 11 5 7 70 F. Dudlely-street 64 — 8 8 4 20 3 7 14 71 Worst...10th E. Church-lane 41 — 11 4 2 6 6 2 10 88 Workhouse Inmates 2 — — - - 1 1 — — — Whole District 307 1 32 68 14 54 45 34 59 57 than the rest. This fever, begining in 1861, but still prevailing in June, 1862, will be considered with more advantage in a future report. Consumptive or Tubercular diseases, another of the important groups which always swell unduly the death-rate of St. Giles's, were distributed throueh the ten sub-divisions of the district as follows:— The Ten Localities—their order of Mortality from Tubercular Diseases, 1861. Order of Sequence, 1861. Locality of Deaths from Tubercular Diseases. Tubercular Mortality per 10,000. From Consumption, Tabes, and Scrofula. From Water-on-tbeBrain. Best lst-2nd. A. Bedford-square 7 - 18 B. Russell-square 9 1 18 3rd I). Bloomsbury-square 7 5 23 4th-5th, E. Church-lane 17 3 43 C. Coram-street 23 5 46 6th L. Lincoln's Inn-fields 11 1 53 7th H. Northern Drury-lane 26 6 62 8th-9th. F. Dudley-street 51 12 70 G. short's-gardens 41 4 71 Worst10th K. Southern Drury-lane 38 4 83 Workhonse Inmates 13 1 — Whole District 213 42 53 The neighbourhoods or Coram Street and Great Wild Street are here found to be those where a notable rise in consumptive mortality has taken place. The parts about Church Lane and the northern district of Drury Lane have had fewer deaths than usual from these complaints. Although in 1861 these diseases were distributed more equally than usual, there was vet the ratio of 4½ to 1 between the worst and the best districts in regard of their mortality from consumption. Diseases of the Breathing- Organs, other than consumption of the lungs, constitute another great order of diseases from which St. Giles's loses a disproportionate number of its residents. In some of the ten localities they produced four or five times as many deaths as in others. 14 The Ten Localities—their order of Mortality from Diseases of the Lungs, 1861 Order of Sequence, 1861. Locality of Deaths from Lung Diseases. Mortality per 10,000. Bronchitis. mation of Lungs & pleura Total. From acute lung diseases. From all lung diseases Chronic. Acute. Best 1st. B. Russell-square 4 2 2 8 7 14 2nd. A. Bedford-square 3 — 5 8 12 20 3rd. L. Lincoln's Inn-fields 2 2 3 7 22 31 4th. H Northern Drury-lane. 11 3 5 19 16 37 5th. C. Coram-street 18 6 6 30 20 49 6th. D. Bloomsbury-square 12 11 7 30 34 57 7th. F. Dudley-street 20 10 26 56 40 62 8th. K. Southern Drurv-lane 12 11 12 35 45 69 Worst 9th-10th E. Church-lane 14 8 15 37 49 79 G. Short's-gardens 18 18 14 50 50 79 Workhouse Inmates 18 — 1 19 — — Whole District 132 71 96 299 32 55 The principal variation from the experience of previous years observed in 1861 consists in the unusual prevalence of lung diseases in the Short's Gardens and Church Lane localities.* And there was a remarkably small mortality from lung diseases in the neighbourhood to the north-east of Drury Lane, where as a rule these diseases in their chronic form largely prevail, owing to the number of Common lodging houses there congregated. Violent deaths, herein including deaths from intemperance and delirium tremens occurred in the ten localities in the following numbers. The two preceding years are given with 1861. Violent Deaths. 1859. 1860. 1861 Total of 3 years. In Locality A 3 — 2 5 „ B 1 1 2 4 „ C 3 2 3 8 „ D 6 7 2 15 „ E 3 1 2 6 „ F 13 11 6 30 „ G 9 8 10 27 H 4 7 11 22 „ K 8 7 2 17 „ L 3 2 — 5 In Workhouse — 1 1 2 Whole District 53 47 41 141 Having regard to the numbers and class of the population in each locality, this result is much what might have been expected, though the neighbourhood of Church Lane would scarcely have been supposed to yield so small a proportion of violent deaths. * It was especially acute lung diseases that caused the mortality in these two districts, where zymotic diseases were also unusually rife. This connection between the zymotic class of diseases and acute lung diseases in their distribution has been before pointed out in these reports. In this instance, however, measles was one of the epidemic diseases in question, and this is notoriously apt to be followed by acute disease of the lungs. It may further more be observed above, that chronic lung diseases again follow consumptive diseases in their prevalence through the several districts. 15 SECTION V.—On the Diseases and Deaths in the Practice of the Public Medical Institutions of St. Giles's in 1861. Statistical data on the amount and nature of the sickness that came under treatment in the practice on the Workhouse and Bloomsbury Dispensary are given in the tables which follow. The figures tell their own story without long comment. It is essential, however, to warn against erroneous conclusions that might be drawn from the mere inspection of these tables as to the prevalence of some diseases. Thus the pauper medical practice always exhibits with disproportionate prominence any disease that is affecting the neighbourhood in which the Workhouse stands : children's diseases and chronic lung diseases for example, that prevail in the poor parts of South St. Giles's and in the common lodging houses. An instance of the unexpected degree to which the Workhouse practice is affected by locality was afforded in 18C1 by the cases of measles and scarlatina. In the whole year only 33 cases of scarlatina were treated by the medical staff of the Workhouse, while 227 ca es of measles came under observation. But, from its mortality being double that of measles, we may infer that scarlatina affected quite as many persons in the district as a whole. And at the Bloomsbury Dispensary 65 cases of scarlatina stand on the books in 1861, while there were only 20 cases of measles. The truth is that the epidemic of measles culminated about Church Lane, that of scarlatina in the Coram Street neighbourhood. The figures of these tables are moreusefully to be compared with the experience of the same institutions in previous ears. At the Bloomsbury Dispensary there was still a slight increase above the high number of patients relieved in former years. Including casualties (which have not been reckoned in former reports) no fewer than 5357 persons received medical and surgical aid in 1861, the average attendance of patients being 440 per week. And how the Dispensary is appreciated by the poor around it is further illustrated by the fact above quoted, that it gave twice the aid in the Coram Street epidemics that was given bv the Workhouse. New Cases treated at Bloomsbury Dispensary, 1861. Quarter ending Physician's Cases. Surgeon's Cases. Total. Admitd. Visited at home. Died. Admitd. Visited at home. Died. Casualties. Admitd. Visited at home. / Mar. 25th 766 159 21 330 40 2 261 1357 199 23 June 24th 808 130 26 392 53 3 255 1455 183 29 Sept. 29th 729 128 19 376 24 — 212 1317 152 19 Dec. 25th 727 170 24 308 54 2 193 1228 224 26 Whole Year 3030 587 90 1406 171 7 921 5357 758 97 It is no unimportant matter that in many cases this chanty stops the begining of pauperism by holding out its hands to a stricken family who must otherwise go to the parish for medical aid. The number of new cases admitted into the Parish Infirmary in 1861 was higher by 128 than the average of the four preceding years. Yet the mortality was only 19½ per cent, of the new cases, instead of being 24 per cent., which had been the ordinary number of deaths in the four former years. Apparently therefore the cases treated in the infirmary were less serious than usual in their character.—Persons visited at their own homes in 1861 numbered 1865, or very closely the same as usual. They died at the rate of 14 per cent., while the average of deaths in this department of the Cases of Disease and Deaths, occurring in the Practice of the Workhouse in 1861, and its four Quarters. Cases occurring— Within Walls of Workhouse, (Infirmary and Inmates). Among Out-Patients attending at Workhouse. Among Patients visited at their own homes. Quarters of the Year. First Quarter. Second Quarter. Third Quarter. Fourth Quarter Whole Year. First. Second Third. Fourth Whole Year. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Cases. New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases. Deaths New Cases Deaths New cases. No deaths. New Cases. Deaths New Cases Deaths New Cases. Deaths New I Cases. Deaths New Cases. s Of all Diseases 248 71 236 50 253 32 352 61 1089 214 923 1081 1442 902 4348 546 85 393 42 401 68 525 63 1865 258 Small Pox — — 1 — — — — — 1 — — — — — — — — — — 1 — — — 1 — Measles — — —; — — — 38 — 38 — 16 11 18 21 66 37 11 9 — 21 — 56 3 123 14 Scarlet Fever — — — — — — 1 — 1 — — 2 1 4 7 1 — 1 — 5 2 18 3 25 5 Hooping Cough — — 4 — 6 — 17 1 27 1 16 30 215 163 424 7 1 11 2 12 1 35 7 65 11 Diarrhoea 1 — 2 — 5 — 1 1 9 1 62 124 368 100 654 * 14 1 17 1 43 — 10 — 84 2 Continued Fever and Febricula 8 3 5 1 4 — 22 3 39 7 72 82 132 80 366 37 2 43 2 53 3 68 11 201 18 Ague 4 — — — — — — — 4 — — — 2 4 6 — — — — 6 — 10 2 16 2 Bronchitis (acute and chronic) 57 24 26 7 23 6 71 11 177 48 296 251 40 27 614 116 19 45 9 13 3 38 3 212 34 Inflammation of the Lungs & Pleura 1 — — — 3 1 9 3 13 4 2 20 17 23 62 18 7 25 5 17 11 11 2 71 25 Consumptive Diseases 29 14 19 16 21 10 27 6 19 96 59 12 25 36 19 92 33 10 28 9 22 11 19 7 102 37 Ophthalmia 5 — 7 — 6 — — 24 — 23 42 11 4 80 1 — 5 — 1 — — — 7 — 17 Workhouse practice had been only 8½ in the four preceding years. Apparently therefore the cases treated at their own homes were of a more serious character than usual. (See opposite Table.) The diseases of the year, as seen in the practice of the workhouse, demand no particular comment. The cases of continued fever received into the infirmary, numbered 39, of which fourteen were recorded as "fever," and twenty-five as "typhus." The mortality of continued fever on a whole was 18 per cent. of the cases, and of typhus 20 per cent. The worst cases of fever being habitually removed to the workhouse, it follows that the cases treated at their own homes comprised fewer cases of typhus, and that their mortality was less. This is seen in the table. But there is here evidence that in the later months of the year many very severe cases of continued fever were treated at their own homes. There is much risk in this practice:—for the form of fever which is most contagious (typhus), because of the danger to others:— for the form which is less contagious (typhoid), because for the patient himself it is of moment that he should be removed from the local conditions under which this form of fever is generated. SECTION VI.—On the Deaths in St. Giles's where there was no Certificate of the Cause from a Medical man or Coroner. There were 41 deaths registered in the twelvemonth by the three registrars, on the mere statement of the friends or neighbours of the deceased, as to the cause of death. No medical certificate was given, and no inquest was held in respect of any of these cases. In each instance the registrar's authority was given for the interment of the corpse, and it was interred accordingly without further enquiry. This proceeding appears to be strictly according to law. Of the 41 persons, thirteen were infants under one day old, and another thirteen were under one year of age. Four of the children appear to have been illegitimate. Twenty -four of the forty-one deaths were among females. Thirteen or nearly a third of the whole happened in and around Dudley Street. The alleged causes of these 41 deaths, as stated to the registrar, may be thus grouped:— "Premature Birth" 4 "Debility," &c 5 "Convulsions" 7 Definite disease 1of the zymotic class... 6 alleged j of other classes 6 Alleged accident 1 " Unknown" 12 Some of the more noteworthy of the instances in question are here extracted:— Jan. 8th, 18G1—At No. 2, Denmark Street, aged six weeks, son of a housemaid, died of debility, diarrhoea; not certified. Feb. 28th,—At No. 9, Montague Mews, aged one month, daughter of a journeyman baker, died of convulsions; no medical attendant. March 10th,—At No. 19, Church Lane, aged one hour, son of a tailor, cause of death unknown ; no medical attendant. April 5th,—At No. 8, Church Lane ; a similar case. March 9th,—At 9, Montague Mews, aged one year, son of a journeyman baker, died of hydrocephalus ; not certified. March 19th,—At No. 51, Chenies' Mews, aged 66 years, a potatosalesman, died of rupture of a vessel on the brain ; not certified. May 5th,—In the Roman Catholic Chapel, Duke Street, aged 54 years, widow of a gold lace weaver, causeof death unknown; diedsuddenly; notcertified. May 13th,—At Angel Yard, aged 45, wife of an ostler, died of diphtheria ; not certified. July 10th,—At No. 23, Chenies' Mews, aged two years, the daughter of a conjurer j died from the falling of a wheel on the head; no medical attendant. The alleged causes of these 41 deaths, as stated to the registrar, may be thus grouped:— " Premature Birth" 4 "Debility," &c 5 "Convulsions" 7 Definite disease alleged of the zymotic class 6 of other classes 6 Alleged accident 1 " Unknown" 12 Some of the more noteworthy of the instances in question are here extracted:— Jan. 8th, 18G1—At No. 2, Denmark Street, aged six weeks, son of a housemaid, died of debility, diarrhœa; not certified. Feb. 28th,—At No. 9, Montague Mews, aged one month, daughter of a journeyman baker, died of convulsions; no medical attendant. March 10th,—At No. 19, Church Lane, aged one hour, son of a tailor, cause of death unknown ; no medical attendant. April 5th,—At No. 8, Church Lane ; a similar case. March 9th,—At 9, Montague Mews, aged one year, son of a journeyman baker, died of hydrocephalus ; not certified. March 19th,—At No. 51, Chenies' Mews, aged 66 years, a potatosalesman, died of rupture of a vessel on the brain ; not certified. May 5th,—In the Roman Catholic Chapel, Duke Street, aged 54 years, widow of a gold lace weaver, cause of death unknown; died suddenly; notcertified. May 13th,—At Angel Yard, aged 45, wife of an ostler, died of diphtheria ; not certified. July 10th,—At No. 23, Chenies' Mews, aged two years, the daughter of a conjurer; died from the falling of a wheel on the head; no medical attendant. 18 Sept. 24th,—At No. 18, Wild Court, aged 4 days, daughter of 8 costermonger, cause of death unknown ; found dead ; not certified. Oct. 16th,—At No. 34, Henrietta Street, aged 4 years, daughter of a journeyman carpenter, died of gastric fever, scarlet fever j not certified. The smallest evil of a system of registration that admits of such entries as these, is the vitiation, pro tanto, of all deductions from the death-returns. Many of the causes of death set down are quite unreliable ; some of them may be true, but formal evidence of their truth should be adduced. It must not be forgotten that in the nineteen cases out of twenty were the cause of death is certified, it is quite optional with the medical practitioner whether he give such certificate or not. Some deaths therefore may have been uncertified because the medical attendant has refused to grant a certificate of the cause. Others will have been uncertified because the attendant is an unqualified practitioner. Again some deaths may have been reported to the coroner and he may have decided, on the circumstances ascertained by him, that no inquest was necessary. Where this is the case it is much to be desired that the fact should be noted by the Registrar. But setting aside all possible cases of this sort there remain a considerable number of uncertified deaths about which there is more serious doubt. Yet the law authorizes the registration of such deaths, and the Registrar General cannot instruct the local Registrars to use any discretion in their entry. Being registered, permission for burial is obtained, and unless rumour should chance to set in motion the police or the coroner, the cause of very suspicious deaths is never ascertained. The deaths extracted above will serve to show how readily disease may be confounded with the results of injury or poison. " Rupture of a vessel on the brain" is simulated very closely in cases of poisoning by alcohol or opium, or may actually have been caused by an injury to the head. The symptoms of "gastric fever" and of an irritant poison may be such as to be with difficulty distinguished even by a medical eye. Medical inquiry again is wanted to affirm "diphtheria" as the cause of death ; it has points in common, not only with other diseases, but with poisoning by the mineral acids. Almost before any other cause for that sudden death in chapel, poison offers itself as a probability. And there must have been some reason that ought to be known for the death of that infant of four days old. It is chiefly for these little ones that the protection of a better registration law is required. SECTION VII.—On the Sanitary Work of 1861. Five hundred and eighty-five houses have received improvement in the past year, a total of 1754 nuisances having been abated. In the following table are indicated the nature of the improvements and the neighbourhoods affected by this sanitary work. The divisions of the districts here employed are the same as those used in considering the localization of disease. By this means, we may hope in a series of years to demonstrate with accuracy a connection between the fluctuations of disease and the changes in the physical conditions surrounding the population. In the total amount of house improvement there is not much difference from year to year. Inspection is chiefly given to those districts where epidemic disease shows itself, and thus Coram Street locality was especially looked after in 1861. A hundred houses here have been improved, and 348 separate items of sanitary improvement have been effected in this neighbourhood alone. Here however there are some places that baffle the endeavours of the sanitary officers to arrest disease in them ; especially the Courts leading out of Little Coram Street. They are culs de sac, under the level of the adjacent Streets, and therefore necessarily ill-drained ; the houses built directly upon House improvements in the several Localities of St. Giles's, effected under the superintendence of Inspector Webb, between March 25th, 1861, and March 25th, 1862. Mouse improvements in Localities. A Around Bedford Square. B Around Russell Square. c Around Coram Street. D Around Bloomsbury- sq. E Around Church Lane. F Around Dudley Street. G Around Short's gardents H Around North ern part of Drury Lane. K Around South ern part of Drury Lane. L Around Lincoln's Inn Fields. Whole District of St. Giles's Number of houses improved. 46 35 100 30 63 83 66 70 74 18 585 Improvements in Drainage. Drains constructed 13 9 20 4 1 5 5 10 2 6 75 Improved or repaired 3 12 10 7 8 16 11 11 10 2 90 Traps fixed 29 12 47 16 14 26 27 34 20 5 230 Cesspools abolished 4 4 7 3 ... 2 3 3 4 10 40 Cesspools cleaned only ... ... ... ... ... 1 ... ... ... ... 1 Stables drained and horse-pools abolished 27 7 22 ... ... ... 1 ... ... 13 70 In Water Closets, Pan, trap, and water provided 15 2 7 3 3 2 4 2 5 3 46 water and apparatus only provided 12 9 32 4 12 21 25 26 23 3 167 Cleaned or repaired 1 4 19 4 38 21 15 17 20 1 140 Newly constructed or re-built 7 ... 2 ... 1 1 1 2 ... 3 17 In. Dust Bins. Newly constructed ... ... 2 2 ... 1 3 1 1 3 13 Repaired or covered 1 ... 5 5 ... 7 8 6 6 ... 39 Paring. Re-laid 18 8 30 3 1 5 4 2 4 6 81 In General Water Supply. Receptacles provided 2 ... 4 3 4 1 1 1 1 3 20 Receptacles repaired 4 ... 17 ... 12 14 1 9 7 3 67 Water provided where none m house before 1 ... 1 ... ... ... 3 ... ... ... 5 In Cleanliness and Repair, Generally repaired 1 1 22 1 7 7 5 6 5 ... 55 Cleansed and lime-whited 29 7 59 17 42 51 45 49 52 9 360 Various accumulations removed. from cellars, &* 1 ... 6 2 13 18 13 10 11 2 76 Ventilation, &c. Ventilation improved 15 8 33 5 19 8 3 8 12 ... 111 Overcrowding reduced ... 1 3 1 8 3 2 ... ... ... 18 Kitchens disused ... ... ... 7 ... 10 10 1 1 1 30 „ made legally habitable ... ... ... ... ... ... ... ... ... ... ... Other rooms disused 1 1 ... ... ... 1 ... ... 1 ... 4 Proceedings taken. First notices 40 17 51 18 16 41 37 22 25 6 273 Second notices, letters, &c 27 3 20 11 5 12 12 10 7 1 108 Summoned ... ... 2 ... ... ... ... ... ... ... 2 Reported to Police or District Surveyor ... ... 5 1 2 5 5 4 ... ... 22 Total improvements 184 85 348 87 183 221 190 198 185 73 1754 20 the clay ; the air everywhere moist and stagnant. The leaseholders have been made to keep the houses clean and free from nuisance, but the task of rectifying the fundamental errors of construction would not appear to devolve upon them. The freehold of the land is with the Foundling hospital, and it happens that the Committee of this hospital has resumed the original leases under which the houses were built in the courts in question. Application was therefore made by the Board of Works to the authorities of this hospital, urging them to make a more thorough improvement of the property than could be demanded from the lessees. The answer to this application was unfavourable,* and the Board of Works is thrown back on their scanty powers of procuring amendment given by law. Meanwhile in June 18G2, an epidemic of measles is prevailing in these courts, and promises to pass through them as unsparingly as scarlatina did in 1861. Once established in this neighbourhood there is peculiar difficulty in getting rid of an epidemic until it has visited every house and room. Lincoln Court, again, has been the subject of negociations with the owner Captain Steuart. In 1S58, all its houses were set to rights, but in so unsatisfactory a manner that the rough habits of the tenants have made them scarcely habitable in 1861. It was thought that the occasion of repairing the houses might be used by Captain Steuart to make some thorough and substantial improvement in his property. The court is narrow, confined, and ill-drained, and the houses in many respects badly constructed. The owner is contented, however, with measures of a temporary and partial kind ; and the court will need to be as usual under constant supervision to remedy nuisances which more thorough improvements would prevent. Drainage works have been very urgently wanted in the houses of Nottingham Court, but have not hitherto been practicable owing to the defective plan of the public sewerage. A new sewer is now being built in this Court and will be a great advantage to the health of the inhabitants. Minor sewers have been constructed for the relief of premises in Pied Bull Yard and Little Britain. A step has been taken since the last annual report in the'case of Nos. 30 and 31 Southampton Mews. At the present date No. 30 is unoccupied, but there is an open cesspool and drain here. At No. 31 repairs are being carried out and sanitary alterations made under the instructions of the Steward of the Duke of Bedford. During the year 1861, four complaints have been received of nuisances in connection with trades. In each case they have been remedied without appealing to the law, on the intervention of the sanitary officers. The cow-houses of the district have been inspected, but it has not been thought necessary to take special steps for their improvement until decision is given by the legislature on a proposition now before the House of Commons for the licensing of cow-houses in the Metropolis. No cow-house ought to be licensed in St. Giles. In this densely populated district they are nuisances, and there is no occasion at all for their * Stating that the Committee have no power at present to interfere, inasmuch as the property is leased by them to various tenants for a term of years; and further. suggesting to the Board the employment of the Metropolis Local Management Act to compel the necessary sanitary improvements. † This Court had a mortality of 22 in its 21 houses in 1861, and the same in 1860 Yet in neither year was there any particular epidemic here. 21 existence. There is satisfactory evidence that under all circumstances of veather and temperature fresh milk can supplied to London by the country. Such milk is also more nutritious and wholesome than that of cows living in dose sheds in the centre of the town. The slaughter-houses have also been examined on several occasions, they have been kept fairly clean and several little improvements have been made in them. Still the substitution of the public abattoir for the private slaughter-house remains a great sanitary necessity. In the course of the year, a circular was addressed to the Medical Officers of Health by Dr. Lethebt, asking for their opinion on certain measures which he had advised to the sanitary authorities of the City of London for checking the consumption of diseased meat. He proposed to instruct the Inspectors of Markets to seize meat of the following descriptions as unfit for human food, viz:— (1) The meat of animals slaughtered in a state of acute inflammatory disease; (2) The meat of animals Is that have wasted from lingering disease; (3) The meat of all animals that have died of disease or accident or other cause than that of the butcher. On these propositions, it may be observed that no one would wish inferior meat to be consumed if the question were only between it and better meat. And it would be hiphly desirable to draw a line between first-class and inferior meat. But the alternative put before the poor man by these large regulations, would appear to be whether he shall eat inferior meat or none at all. By advancing the price of meat so as to condemn the poor to vegetable food, their capabilities of work are lessened, and they are unfitted for resisting disease. It is important therefore not to condemn meat of whose unwholesomeness there is not bond fide evidence. In respect of some few diseases affecting animals this evidence exists ; for example, measles in the pig, and malignant carbuncle in the ox. On the other hand, there is no proof that harm can arise from eating the flesh of animals suffering from tubercular deposit in their lungs. A vast number of creatures daily slaughtered in London, probably a really large proportion of them, present an early stage of such deposit and they would be condemned by Dr. Letheby's second rule. What is wanted is not a general measure of confiscation on our present imperfect knowledge, but a system of inspection by which animals should be condemned if they are found affected with diseases known to give an injurious quality to their meat. Hereby fresh information could be gathered as to the connexion between the meat of unsound animals and disease in the human subject. By due arrangements this inspection might be contrived to give a guarantee of the healthiness of all animals from which meat of the first-class is supplied, leaving the meat of inferior or unsound animals, when it is not demonstrably unwholesome, for the consumption of those who cannot afford to pay for such a guarantee. But no such inspection can be got under the present plan of slaughtering. It can only be obtained at central abattoirs under the controul of the sanitary authorities. This is only one, though a chief, ground for desiring such establishments. Against them is only to be urged the convenience of butchers and the alleged difficulty of relying on the honesty of journeymen when out of their masters' sight. GEORGE BUCHANAN. 75, Gower Street, June, 1862. APPENDIX. TABLE I.—Mortality per Thousand in London, in the Divisions of London, and in St. Giles's in 1861, and in preceding Years. Notb—The numbers are computed on an estimate of the population of the period named, and comparison made throughout from the printed returns of the Registrar-General. Mean of 10 years, 1847 to 1856. Death-rate of 5 last years, each corrected to 365j days. 18.57 1858 1859 1860 1861 London 24.46 22.07 23.98 22.77 22.57 23.17 West Districts. -(Kensington, Chelsea, St. George, Hanover-square, Westminster, St. Martin, St. James) 22.76 20.86 22.44 21.51 22.24 22.38 Noktii Districts.— (Marylebone, Hampstead, Pancras, Islington, Hackney) 22.15 21.16 22.96 21.74 21.24 22.30 Central Distrits.—(St. Giles Strand, Holborn, Clerkenwell, St. Luke. East London, West London, London City) 24.35 23.40 24.55 24 22 23.42 25.04 East Districts.—(Shoreditch, Betlinal Green, Whitechapl.,St. George East, Stepney, Poplar). 25.84 24.24 25 87 24.03 24.16 24.05 Sooth Districts.— (St. Saviour, St. Olave, Bermondsey, St. Geoige, Southwark. Newington, Lambeth, Wandsworth, Camberwcll, Rotherhithe, Greenwich, Lewisham.) 26.28 21.15 24.04 22.69 22.22 22.78 St. Giles's 26.89 26 58 24.89 24.94 24.98 25.75 TABLE II.—Deaths in Hospitals among Patients brought from St. Giles's and neighbouring Districts, 1861. Districts. Total ascertained Deaths in London Hospitals. Kings College Hospital, (Strand). Middlesex Hospital (Marylebone). Cliaring Cross Hospital (St. Martins) University College Hospital (St. Pancras) Children's Hospital (Holborn). St. Bartholomew's Hospital W, (London) Royal Free Hospital (St. Pancras). London Fever Hospl. (Islington). Westminster Hospital (Westminster). St. Mary's Hospital (Paddington). Deaths in Hospitals 1 out of the district. St. Pancras 185 4 39 3 78 26 7 21 7 ... ... 86 St. Marylebone 168 2 77 2 18 4 4 0 13 ... 48* 91 Metropolis 3569 147 235 70 161 99 611 63 118 143 171 ... Holborn 83 19 4 2 3 10 37 5 3 ... ... 73 Strand 62 26 17 10 2 2 3 0 2 ... ... 36 St. Martin's 30 7 2 19 0 1 0 0 1 0* ... 11 St. Giles's 76 28 17 8 12 5 5 1 0 0* ... 76 1 he figures in the above table were obtained by personal inspection oj the books oj the several Hospitals, with the exception of those marked with a star, and for these 1 have to thank Dr. Thomson and Mr. Beale, the Officers of Health of the respective districts. TABLE III—Causes of Deaths in St. Giles' in 1861, with the Ages at Death- (Deaths in Hospitals are here included.) Class. Causes of Death. At all Ages. Under 2 years. 2 and under 5. 5 and under 10 10 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards Males. Females. Total. All causes 755 700 1461 458 177 62 45 28 85 105 147 146 127 69 12 Specified causes 746 694 1440 447 177 61 45 28 84 103 144 144 126 69 12 I (Classes.) Zymotic Diseases lf64 175 339 151 99 36 11 4 13 10 8 2 4 1 ... II. Constitutional „ 175 140 315 58 23 11 16 16 43 39 59 36 10 3 1 III. Local „ 330 305 635 164 51 14 14 6 25 51 71 104 105 27 3 IV. Developmental „ 59 61 120 60 2 ... 1 2 ... 1 ... 1 7 38 8 v Violent. Deaths 18 13 31 14 2 ... 3 ... 3 2 6 1 ... ... ... I. (Orders.) 1. Miasmatic Diseases 145 162 307 131 99 36 11 3 10 8 4 2 3 ... ... 2. Enthetic „ 10 7 17 13 ... ... ... 1 1 ... 1 ... ... 1 ... 3. Dietic „ 8 5 13 5 ... ... ... ... 2 2 3 ... 1 ... 4. Parasitic „ 1 1 2 2 ... ... ... ... •• ... ... •• ... ... ... 11. 1 Diathetic „ 9 25 34 ... ... ... 1 1 ... 3 6 12 7 3 1 2. Tubercular „ 166 115 281 58 23 11 15 15 43 36 53 24 3 ... .... III. 1. Diseases of Nervous System 87 79 166 59 18 5 6 ... 4 10 17 17 24 4 2 2. „ of Organs of Circulation 38 41 79 1 2 1 1 1 5 7 17 22 17 5 ... 3. „ of Respiratory Organs 164 139 303 99 30 4 2 ... 6 17 26 52 49 13 1 4. „ of Digestive Organs 22 31 53 4 ... 2 3 ... 6 8 9 ... 13 3 .... 5. „ of Urinary Organs 16 8 24 ... ... 1 ... ... 3 5 2 8 2 2 ... 6. „ of Organs of Generation ... 3 3 ... ... ... ... ... ...... 3 ... ... ... ... ... 7. ., of Organs of Locomotion 2 2 4 ... ... 1 2 ... ... 1 ... ... ... ... ... 8. „ of Integumentary System 1 2 3 1 1 ... ... ... 1 ... ... ... ... •• IV. I. Dev. Diseases of Children 22 13 35 34 1 ... ... ... ... ... ... ... ... ... ... „ of Adults ... 4 4 ... ... ... 1 2 ... 1 ... ... ... ... ... „ of Old Peo- pie 20 34 54 ... ... ... ... ... ... ... ... 1 7 38 8 4. Diseases of Nutrition 17 10 27 26 1 ... ... ... ... ... ... ... ... ... ... V. 1. Accident or Negligence 12 9 21 11 2 ... 2 ... 2 ... 3 1 ... ... ... 3. Homicide 1 2 3 2 ... ... ... ... 1 ... ... ... ... ... ... 4.. Suicide 5 ... 5 ... ... ..00000000000000000. ... ... ... 2 2 ... ... ... ... 5. Execution ... ... ... ... ... ... ... ... • • ... ... ... ... Violent Deaths not classed ... 2 2 1 ... ... ... ... ... ... 1 ... ... ... ... Sudden Deaths, cause unascertaomed ... 1 1 ... ... ... ... ... ... ... 1 ...... ... ... ... Causes not specified or illdefined 9 11 20 11 ... 1 ... ... 1 2 2 2 1 ... ... TABLE III—(continued.) Diseases in Orders- Class. Causes of Death. At all Ages. Under 2 years. 2 and under 5. 5 and under 10. 10 and under 20 20 and under 25. 25 and under 35 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. Male. Female Total. I Order 1. 1 Small Pox ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 Measles 18 14 32 25 7 ... ... ... ... ... ... ... ... ... ... 3 Scarltina 30 38 68 15 32 13 7 ... 1 ... ... ... ... ... ... 4 Diphtheritis 6 8 14 3 5 5 ... ... ... ... 1 ... ... ... ... 5 Quinsy ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 6 Croup 19 24 43 18 20 5 ... ... ... ... ... ... ... ... ... 7 whooping Cough 15 39 54 31 22 1 ... ... ... ... ... ... ... ... ... 8 Typhus and Infantile Fever 23 12 35 I 6 10 3 2 5 4 2 2 ... ... ... 9 Erysipelas 3 ... 3 2 ... ... ... ... ... ... ... ... 1 ... ... 10 Metria ... 3 3 ... ... ... ... ... 3 ... ... ... ... ... ... 11 Carbuncle 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Dysentery 2 1 3 1 1 ... ... ... ... ... ... ... ... ... ... 14 Diarrhœa 10 14 33 28 2 1 ... ... 1 ... 1 ... ... ... ... 15 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Ague ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... 17 Remittent Fever 4 5 9 4 ... ... ... ... ... ... ... ... ... ... ... 18 Rheumatism 4 2 6 ... ... 1 1 1 ... 3 ... ... ... ... ... Order 2. 1 Syphilis 8 7 15 13 ... ... ... 1 ... ... 1 ... ... ... ... 2 Stricture of Urethra 2 ... 2 ... ... ... ... ... I ... ... ... ... 1 ... Order 3. 1 Privation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Want of Breast Milk 3 1 4 4 ... ... ... ... ... ... ... ... ...... ... ... 3 Purpura and Scurvy ... 1 1 1 ... ... ... ... •• ... ... ... ... ... ... 4 Alcoholism.— a Delirium Tremens 3 9 5 ... ... ... ... ... 1 2 2 ... ... ... ... b Intemperance 2 1 3 ... ... ... ... ... 1 ... 1 ... 1 ... ... Order 4. 1 Thrush 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... II. Order 1. 1 Gout 2 ... 2 ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Dropsy ... 2 2 ... ... ... ... ... ... ... ... ... 2 ... ... 3 Cancer 6 19 25 ... ... ... 1 1 ... 2 6 10 2 3 5 Mortification 1 4 5 ... ... ... ... ... ... ... ... 1 ... ... 1 Order 2. 1 Scrofula 5 3 8 4 2 ... ... ... 2 ... ... ... ... ... ... 2 Tabes Mesenterica 6 7 13 7 1 3 2 ... ... ... ... ... ... ... ... 3 Phthisis 131 80 220 17 10 8 13 15 41 36 53 24 3 ... ... 4 Hydrocephalus 24 16 40 30 10 ... ... ... ... ... ... ... ... ... ... III. Order 1. 1 Cephalitis 8 6 14 3 3 2 3 ... ... 3 ... ... ... ... ... 2 Apoplexy l5 12 27 ... ... ... 1 ... ... 1 8 7 9 1 ... 3 Paralysis 17 8 25 ... ... ... ... ... ... 2 4 7 10 1 1 4 Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Epilepsy 5 9 14 ... ... ... 2 ... 2 ... ... 1 2 ... 1 7 Convulsions 31 37 68 54 11 3 ... ... ... ... ... ... ... ... ... 8 Other Brain Diseases 11 7 18 2 4 ... ... ... 2 ... 3 2 3 2 ... Order 2. 1 Pericarditis 1 2 3 ... 1 ... ... 1 ... ... ... ... 1 ... ... 2 Aneurism 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 3 Heart Disease, &c 36 39 75 1 1 1 1 ... 5 7 17 22 15 5 ... Order 3. 1 Laryngitis 3 1 4 2 1 ... ... ... ... ... ... 1 ... ... ... 2 Bronchitis 98 88 186 54 7 1 ... 2 2 5 19 41 44 10 1 3 Pleurisy 1 4 5 ... 1 1 ... ... ... 1 1 ... 1 ... ... 4 Pneumonia 46 38 84 43 21 2 1 1 1 5 3 2 3 2 5 Asthma 14 7 21 ... ••• ... ... ... 2 6 3 8 1 1 ... 6 Other Lung Diseases „ 2 1 3 ... ... ... 1 1 1 ... ... ... ... ... ... Order 4. 1 Gastritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Enteritis 3 6 9 3 ... 1 1 ... 1 1 ... ... 1 1 ... 3 Peritonitis 1 4 5 1 ... ... 1 ... 1 ... 1 ... 1 ... ... TABLE III. Diseases in Orders-(cosTiNUED.) Class. Causes of Death At all Ages. Under 2 years 2 and under 5 5 and under 10 10 and under 20 20 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and under 15 85 and upwards. Males. | Females. Total. 4 Ascites 1 3 4 ... ... ... ... ... 1 ... ... 1 2 ... ... 5 Ulcer. Intest 2 ... 2 ... ... ... 1 ... ... ... 1 ... ... ... ... 6 Hernia 1 4 5 ... ... ... ... ... ... 1 2 1 1 ... ... 7 Ileus ... 3 3 ... ... ... ... ... ... 1 1 ... ... 1 ... 8 Intussusception ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 9 Strict. Intest ... 1 1 ... ... ... ... ... ... 1 ... ... ... ...... ... 10 Fistula ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 11 Stomach Disease, &c 4 2 6 ... ... ... ... 1 1 1 2 ... ... 12 Pancreas Dis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hepatitis 2 3 5 ... ... ... ... .... 1 2 ... 1 ... 1 ... 14 Jaundice ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Liver Dis. &c 8 5 13 ... ... 1 ... ... 1 1 3 1 6 ... ... 16 Spleen Dis. &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5. 1 Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Nephria 4 5 9 ... ... ... ... ... 2 4 1 2 ... ... ... 4 Diabetes 1 1 2 ... ... ... ... ... ... ... 1 1 ... ... ... 5 Stone ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Cystitis 4 ... 4 ... ... ... ... ... ... ... ... 2 1 1 ... 7 Kidney Disease, &c 7 2 9 ... ... 1 ... 1 1 1 ... 3 1 1 ... Order 6. 1 Ovarian Dropsy ... 2 2 ... ... ... ... ... ... 2 ... ... ... ... ... 2 Uterine Disease, &c ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... Order 7. 1 Arthritis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 Joint Disease. &c 2 2 4 ... ... 1 2 ... ... 1 ... ... ... ... ... Order 8. 1 Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ulcer ... 1 1 ... ... ... ... ... I ... ... ... ... ... ... 3 Skin Disease, &c 1 1 2 1 1 ... ... ... ... ... ... ... ... ... ... Order 1. IV. 1 Premature Birth 9 6 15 15 ... ... ... ... ... ... ... ... ... ... ... 2 Cyanosis 3 3 6 5 1 ... ... ... ... ... ... ... ... ... ... 3 Spina Bifida ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Other Malformns 1 1 2 2 ... ... ... ... ... ... ... ... ... ... ... 5 Teething 9 3 12 12 ... ... ... ... ... ... ... ... ... ... ... Order 2. 9 2 Childbirth (see Metria) ... 4 4 ... ... ... 1 2 ... 1 ... .... ... ... ... Order 3. 1 Old Age 20 34 54 ... ... ... ... ... ... ... ... l 7 38 8 Order 4. 1 Atrophy and Debility 17 10 27 26 1 ... ... ... ... ... ... ... ... ... ... V. Order 1. (Accident or Negligence.) 1 Fractures. &C 4 2 6 1 ... ... 1 ... .... ... 3 1 ... ... ... 2 Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Burns, &c 2 2 4 ... 2 ... 1 ... ... 1 ... ... ... ... ... 4 Poison .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Suffocation 4 5 9 9 ... ... ... ... ... ... ... ... ... ... ... 7 Otherwise 2 ... 2 1 ... ... ... ... 1 ... ... ... ... ... ... Order 3. Homicide 1 2 3 2 ... ... ... ... l ... ... ... ... ... ... Order 4. (Suicide) 1 Wounds—Gunshot ... ... •• ... ... ... ... ... ... ... ... ... ... ... ... „ Cut, Stab 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 2 Poison 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 3 Drowning 1 .. 1 ... ... ... ... ... ... ... 1 ... ... ... ... 4 Hanging 2 ... 2 ... ... ... 1 ... ... ... 1 ... ... ... ... 5 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• Other Violent Deaths ... 2 2 1 ... ... ... ... ... ... 1 ... ... ... ... Sudden Deaths ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... Cause not specified 9 11 20 11 ... 1 ... ... 1 2 2 2 1 ... ... TABLE IV.—Comparison of Mortality from various causes in London, and in St Giles's. Four Quarters, 1861. Class. Classes and Orders or Disease. First Quarter. Second Quarter. Third Quarter, Fourth Quarter. London. St. Giles. London. St. Giles. London. St Giles. London. St. Giles. Estimated Quata. Actual Number. Estimated Quota. Actual Number. Estimated Quota. Actual Number. Estimated Quota. Actual Number. All Causes 18965 355.6 445 15238 293.7 337 14932 287.8 288 15866 305.8 391 Specified Causes (Classes.) 18815 352.8 436 15030 289.7 332 14777 284.8 286 15666 302.0 386 I. Zymotic Diseases 3674 68.9 85 3292 63.5 50 4732 91.3 86 4012 77.3 118 II. Constitutional „ 3488 65.4 82 3442 66.3 86 3076 59.2 67 3076 59.2 80 III Local „ 8768 164.5 212 5046 114 6 164 4555 878 102 6300 121.5 157 IV. Developmental,, 2252 42.2 48 1840 35.4 24 1828 35.2 23 1760 34.0 25 V. Violent Deaths (Orders.) 633 11.8 9 510 9.9 8 586 11.3 8 518 100 6 I. 1. Miasmatic Diseases 3343 62.7 76 3017 58.1 44 4357 84.0 77 3712 72.1 110 2. Enthetic „ 110 2.1 5 90 1.8 4 96 1.9 6 94 1.8 2 3. Dietic „ 188 3.5 4 165 3.2 1 219 4.3 3 148 2.9 5 4. Parasitic „ 33 6 ... 20 .4 1 60 1.1 ... 28 .5 1 II. 1. Diathetic „ 613 11.5 9 573 110 10 515 99 10 557 10.6 5 2. Tubcrcular „ 2875 53.9 73 2869 55.3 76 2561 49.3 57 2519 48.6 75 III. 1. Dis. of Nervous Syst. 2012 37.7 46 1672 32.2 43 1472 28.4 37 1580 30.5 40 2. „ Organs of Circulation 880 16.5 29 686 13.2 20 585 11.3 15 699 13.5 15 3. „ Respiratory Organs 4798 90.0 114 2535 48.9 77 1467 28 3 37 2935 56.6 75 4. „ Digestive ditto 653 12.2 15 667 12.8 13 703 13.6 10 712 13.7 15 5. „ Urinary ditto. 266 5.0 5.0 214 4.1 8 193 3.7 1 226 4.3 10 6. „ Organs of Generation 41 .8 1 58 1.1 ... 52 1.0 1 55 l.l 1 7. „ „ Locomotion 45 .9 2 54 1.1 2 34 .6 ... 41 .8 ... 8. „ Integumentary System 73 1.4 ... 60 1.2 1 49 1.0 1 52 1.0 1 IV. 1. Dev. Dis of Children 590 110 13 560 10.8 7 437 8.5 7 450 8.7 8 2. „ „ Adults 75 1.4 1 63 1.2 2 60 11 1 52 1.0 ... 3. „ „ Old People 847 15.8 27 547 10.6 10 495 9.5 6 627 12.1 „ 4. Diseases of Nutrition 740 14 0 7 670 12.8 5 836 16.1 9 631 12.2 6 V. 1. Accdt. or Negligence 540 10.1 6 413 8.0 4 485 9.4 5 432 8.4 6 2. Suicide 65 1.2 1 76 1.5 2 59 1.1 2 61 1.1 ... All other Violent Dths. 28 .5 2 21 .4 2 42 .8 1 25 5 ... Sudden Deaths 47 .8 ... 35 .6 1 43 .8 ... 39 .7 ... Cause unspecified . 103 2 0 9 173 3.4 4 112 22 2 161 31 5 I. Certiin Special Diseases. Small Pox 73 1.4 ... 52 1.0 1 44 .8 ... 46 .8 ... Measles 436 8.2 19 271 5.3 3 192 3.7 2 171 3.3 8 Scarlatina 420 8.0 11 326 6.3 1 467 9.0 15 1145 22.0 41 Diphtheritis 139 2.6 7 159 3.1 2 168 3.2 2 231 4.5 3 Croup 236 4.5 16 190 3.7 8 177 3.4 8 252 4.8 11 Whooping Cough 1113 20.9 8 1151 22.2 14 633 12.2 12 600 11.6 20 Diarrhæa 215 4.0 3 204 4.0 4 1869 36.0 24 337 6.4 2 Typhus and other Fever, continued & remittent 378 7.1 7 373 7.2 7 446 86 13 655 12.6 17 Deaths in Hospitals here included. Population of St. Giles, 1: 51.88 part of the Population of London at census of 1861. TABLE V.—Registered Deaths in 52 Weeks of 1861. Sub-Districts of St. Giles's Here the Deaths registered in error are omitted, Deaths in Sub-Districts. [Population 1861, corrected.] First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year, 1860 M. F. M. F. M. F. M. F. M F. Both Sexes St. George, Bloomsbury. [17392.] 42 46 33 47 30 32 53 49 158 174 332 St. Giles's, South. [19474.] 129 76 75 74 60 62 87 80 351 292 643 St. Giles's. North. [17183] 61 72 41 45 40 47 52 52 194 216 410 Whole District. [54049.] 232 194 149 166 130 141 192 181 703 682 1335 TAELE VI-—Registered Births in 52 Weeks of 1851- Sub-Districts of St- Giles's Births in Sub-Districts. First Quarter. Second Quarter Third Quarter. Fourth Quarter. Whole Year. 1860. M. F. M. F. M. F. M. F. M. F. Total Children St. George, Bloomsbury 47 61 56 48 53 62 46 43 202 431 214 416 St. Giles's, South 120 103 118 89 94 103 99 77 377 808 St Giles's, North 76 77 52 76 69 61 63 58 260 272 532 Whole District 243 246 226 213 216 226 208 178 893 863 1756 TABLE VII —Houses and population of the Ten Sub-divisions of St Giles's From the Census of 1861- LOCALITT OF INHABITED HOUSES. RESIDENTS. A Bedford-square 508 3948 11 Russell-square 810 555l C Coram-street 649 6104 D Hlootnsbury-square 536 5251 E Church-lane 324 4674 F Dudley-street 511 9047 G Short's-gardens 3S4 6306 H Northern Drury-lane 370 5155 K Southern Drury-lane 274 5057 L Lincoln's-inn-fields 303 2261 Workhouse 1 695 Total 4675 54049 Here Eve Terrace, Old St. Pancras-road (thirteen houses and eighty-eight residents) is, for brevity's sake, included in locality A. The enumerator's returns on which this Table s based, were kindly furnished by the Registrar-General. T. Penny, Printer, 121, Leman Street, Whitechapel.